S2235 Endoscopic Retrograde Appendicitis Therapy Using a Single-Operator Cholangioscope for Acute Appendicitis: A Systematic Review

Introduction: Surgery has long been the standard of care for appendicitis. Recently, endoscopic retrograde appendicitis therapy (ERAT) has emerged as a novel non-surgical treatment usually done with fluoroscopy. Here, we aimed to summarize available data on the efficacy and safety of using a single-operator cholangioscope for ERAT without the need for fluoroscopy. Methods: We systematically searched PubMed using the following search strategy “Endoscopic Retrograde Appendicitis Therapy AND (cholangioscope OR cholangioscopy).” We included patients with acute appendicitis undergoing ERAT with cholangioscopy. Studies of patients with chronic appendicitis or reviews were excluded. Appendicoscopy findings and treatment modalities were recorded. The outcomes of interest were technical/clinical success, adverse events and disease recurrence. Results: Six studies with a total of 19 patients were included. The technical success rate (defined as procedure completion) and the clinical success rate (defined as resolution of pain) were both 100%. The most common findings on appendicoscopy were mucosal edema, fecaliths and pus. Lavage was the most common ERAT modality and was effective in 17/19 cases without need for addition intervention. Lithotripsy and stenting were also performed in single cases respectively. There were no reported adverse events or appendicitis recurrences. Conclusion: ERAT without the need for fluoroscopy appears to be a safe treatment for patients with acute appendicitis who are at high risk for surgery or who decline surgery. Our findings suggest a high technical and clinical success rate with no reported disease recurrences. This is a novel technique and as such, further studies are needed because of significant limitations due to the availability of only small uncontrolled studies.